Trigger Finger

  • Most common in the sixth decade, women, people with diabetes or rheumatoid arthritis and in the dominant hand
  • Caused by inflammation and contriction of the flexor tendon sheath through which the flexor tendons run from palm to the finger
    • Causes irritation of the tendon, and occasionally formation of a nodule, which impinges on the tendon movement, causing pain and restriction of finger movement
    • In the finger, there are 5 annular ‘pulleys’ which hold the tendon close to the bone.  The A1 pulley (at the metacarpal head) is the first and subject to most force.
      • It is here where triggering tends to occur
  • Presentation
    • Intermittent painful locking of the finger in flexion (ask how easy this is to overcome, as this can indicate severity)
    • Examination may reveal palmar or digital nodule
      • look also for any evidence of rheumatoid, carpal tunnel (often concurrent)
  • Management
    • Local (A1) steroid injection (57% resolve after 1 and 86% with 2 injections)
    • Surgery (usually if 2 steroid injections have failed)
    • Splinting is also an option (can be effective but often causes stiffness)

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